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124 Cards in this Set
- Front
- Back
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28 millon Americans suffer from migraines, what is ratio of women to men
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3:1
women suffer more |
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50% of migraines are severe and disabling
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YES
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What are the types of primary HAs, and common vs classic
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Migraine w/ aura (classic)
Migraine w/o aura (COMMON) Tension-type HA Cluster HA |
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What primary HAs have a vascular componet
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migraine w/ and w/o aura, and cluster HA
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What primary HA are due to muscle contraction
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tension-type HA
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Secondary HA are due to another cause which includes
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MINT HV
metabolic disorders infection cranial NEURALIAS, disorders of face adn NEXK Toxic substances Head tramuma and Vascular and NOn-vascular disorders |
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What medication can cause a rebound HA
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analgesic, ergotamines, caffiene and triptans
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What is difference in MOH (medication overuse HA) with triptans
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are MIRGAINE rebound HA, vs others are tension-type
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You should limit use of analgesics, ergotamines, caffiene and triptans to what use
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2-3 days per weeks for abortive therapy
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What causes MOH
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withdrawl symptoms on discontinuation of medication
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Do pts with MOH have increase use of the medcioatn, and increase severity of HA
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YES
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Internation HA society criteria for Migrain w/o aura, states you must have at least
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5 attacks with HA lasting 4-72 hours
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International Soceity for Mirgain w/o aura also states must have 2 of the following
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UPAM
unilateral (starts) pulsating quality moderate/severe intensity aggravtes by ph yscial activyt |
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For Migrain w/o you also must at least 1 of the followign
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Nausea/Vomiting
or Photophobia or phonophobia |
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How many attacks are required for migraine W/ AURA
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at least 2 attacks with 3 or more of the following
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For Migraine with Aura, you need at least 3 of the followign
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Aura fully reversible
develops gradually over 4 minutes or in 2 succes Does NOT last >60minutes, and migraine follwig with 60minutes |
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What is included in the physical exam for migraines
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Vital signs (temp, BP, pulse
Neurological exam Cervical/spinal exam visucal felids |
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Migraines in general are mutifactoral, what is genetic characteristic
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autosomal dominant
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When do most migraines develop
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1st 3 decades of life
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Do estrogens aggravate migraines
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YES
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What are migraine triggers
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Increased or decreased sleep
stress medications smoking perfumes and foods |
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What occurs in the prodomes phase prior to a HA
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craviing, tried yaming, and heightened persion, and fluid renetions
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What gender is usually affect by Cluster HA, and onset
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males--27-30 years of age
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What is typical duration of Cluster HA
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15 minutes to 3 hours
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Cluster HA have EXCURICATION pain, where are 98% located
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unilateral
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Are N/V present in cluster HA
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NO--ONLY MIGRAINES
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In Cluster HA, pts usally cannot remain still paces
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YES--different from migraine--want to retreat to DARK places
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How many attacks per month and years with TENSION-type HA
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greater than or eqal to 15/days per month or 180 days/years
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Tension type HA the PAIN does NOT prohibit actives, what is pain like
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BILATERAL
dull and band like |
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Is there N/V with Tension-type HA
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NO--ONLY migranes
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What is migraine generator
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brain stem
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The Reticular activating system in the brain stem, stimulates
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brain stem nuceli which stimulate the menigneal blood vessles
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The menigneal blood vessels (peripherall) stimulate by the brain stem nucleli to release what POTENT VASODIALTORS
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nitric oxide and plama proteins
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What do please protein and release of nitric oxide trigger
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peripheral trigemial nerve
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What does the perihperal trigeminal nerve release
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Calcitonin-gene related peptide
Substance P Neurokinin-A which causes neurogenic inflammation |
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What happens after neurogenic inflammation
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moves central again thorugh the thalamus to higher brtain centers
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What are the acute goals of migraine therapy
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reduce the intensity and duration of pain and symptons
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Does migraine therapy have an effect on aura
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NO--must take at onset of pain
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Prevenitive therapy is used to prevent occurene of migraine, does it matter how many attacks they have per month
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NO
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What are behavior therapy options to prevention migraines
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avoid triggers
stress reductions application of ice stop smkoong |
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What is the most efffective nevahior therapy with recurrent migraines
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sleep and relaxation, which results in 50% reduction in migraines
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What are preventive agents for migraine
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Antidepressants
Antiepiletics Beta-blockers CCB Cyproheptadine COX-2 inhibitors/NSAIDS Methysergide |
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Beta-blockers are equal in effacicty to
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CCB
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What are the 2 Beta-blockers FDA approved for prevention of migraine
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Propranolol
Timolol |
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What is MOA of beta in migraines, and risks
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unknown MOA, risk with asthma, heart block, allthe's
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How long to full benefit with beta blockers
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several months
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What agents may be used in preganacy to prevent migraines (except 3rd trimester)
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magnesium
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Are any CCB FDA approved for migraine prevention
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NO
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What is MOA of CCB and how long till effective
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interaction with CNS neurotransmission, and may require 3 weeks to 2 months for full benfits
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Antidepressants are NOT FDA approved for prevention of migraines, what 2 are used, may cause sleep--so potential benefit in pts trigger by sleep deprevation
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amitriptyline
nortiptyline |
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What is MOA of antidpressants, and risks
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inhbiit 5HT2 receptors, and have antichloingeric effects and CNS
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What are the AED approved for preventive migraine therapy
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Valproate
Topiramate Levetriacetam, gabapentin, and pregabalin |
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What AED are FDA approved
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Valproate
Topiramte |
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What are SES of Valproate
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weight gain, tremor and hair loss
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What is are SEs of Topiramte
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parasehtsis, kidney stones
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What is MOA of cyproheptaidine
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potent steroin and histamine antagoinst--unkonw
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Risk of Cyproheptadine
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sedation, anticholginer and WEIGHT GAIN
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What is MOA of Methyserfide
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serotonin receptor antagoinsts--ergotamine
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What are risks with methsergide
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retroperinoeal,endocaridal, and pleuroplmonary fibrosis with prolonged therapy
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Methysergide must be slowly tapered off over 2-3 weeks, to avoid rebound, adn what is required after 6 months therapty
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drug holidy for 3-4 weeks
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Methsergide is only available as
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compounded agents
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NSAIDs may also be used as preventive but may also cause rebound
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YES
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Premere is also used for prevenative thearpy in pts with
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patent formaen ovale (hole between septums of heart)
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In pts with Patent foramen ovale there is a link with what type of migrane
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migraine w/ aura
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What is MOA of premere
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filters blood--as unfilered blood may trigger migraines
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What is the effect of migraine of GI motility
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decrease GI moltility, reduces oral absoprtion of medications
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Many pts with migraine have N/V, what should be considered
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antiemetics
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What dose devlier form has the fastest onset of action
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self-injections
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How is the oral disintegrating tablet absobed, and ONLY benefit
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gastric absoprtion--no faster onset of action, ONLY benefit is DONT need water
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What is the receptor that ALL TRIPTAN work at
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5HT1B/D AGONIST
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What are uses of TRIPTANS
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acute, moderate to severe migranes, cluster HA, and menstrual mgraine
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What is the preferred treatment for Cluster HAs
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injectable
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TRIPTANS are used by trial and error, and MOA is neuronal inhibition at trigeminal nevere AND
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vasocotnrition of meningela, dural and cerebral arterals
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Do TROPTANS affect regional cerberal blood flow
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NO
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Sumatriptan has additional reeptor site of action which is
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5HT 1B/D 1F agoinst
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What is duration of action of SUmatriptan
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short
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What are available formulations of Sumatriptan, and ONSET
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tablet 30
injection 1o Nasal formations 15 |
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What is metabolism of Sumatripan
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MAO-A
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Is there a combo Sumatriptan and naproxen for acute treatment of HA
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YES
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What are dosage forms of Zolmitriptan (Zomig)
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Tablet
ZMT (MELT) Nasl spray (NS) |
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What is Duration of action of Zolmitriptan
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Short
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What is metabolism of Zomitriptan
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P450 and MAO-A
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What is duration of action of Naratriptan (1mg and 2.5mg tablets)
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LONG
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Naratriptan should NOT be choosen to get rid of HA fast, rather is it best
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if you can predict HA--such menstrual HAs
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What is meatbolism of Naratriptan
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P450
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Is Naratriptan marketed as an alternative for pts who requre repeat dosing with other migraine therapies
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YES
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Rizatriptan is available at 5,10mg tablets, and MLT, what is max dose
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30 or 40mg day
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What is duration of action of razatriptan, and onset
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SHORT---30-90
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What is metabolism of Rizatriptam
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MAO-a
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When pts take BOTH rizatriptan and propranolol, what dose should they recieve initally
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2.5-5mg with max 15mg/day
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THe MLT of Rizatriptam is what flavor, and BAD
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mint flavor, and can make some pts more nauseous
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Do the MLT take longer to reach max concentration
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YES 1.6-2.5 hours vures 30-90
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Almotriptan is available as 6.25mg and 12.5mg tablets is duration of action
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SHORT
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What is metabolism of Alomotriptan
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CYP3A4, 2D6, and MAO
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What is TRUE benefit of almotriptan
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may be better tolerated than other triptans
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Frovatriptan is available as 2.5mg what is its duration of action
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LONG----half of 26 hours
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What is metabolism of Frovatriptan
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renal and CYP1A2
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What are drug interactions with Frovatriptan
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BCP may increase Cmax and ACU
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Eletriptan is available at 20mg or 40mg, what is duration of action
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MEDIUM
fast onset--and little bit longer half-life |
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What is metabolism of Eletriptan
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CYP450 3A4
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Eletriptan shoudn not be used within 24 hours of a
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ptoent 3A4 inhibitor
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What drug increase the AUC of eletriptan
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propranolol---other one that increase propranolol is rizatriptan
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Eletriptan SHOULD not be given to pts with SEVERE
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hepatic impiarment
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What are adverse drug reactions of triptans
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Chest pressure
Flusing/dissinzes parestheia drowsines nausea neck pain or stiffness |
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What are contraindicaitons of triptans
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BPH CD
Breastfeeding/pregnancy prinmetazl angina hypercholertemia/heptaic disease CAD, complicated migranes Diabeties |
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What drugs are metabolized by MAO
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RAZS
Rizatriptan Almotriptan Zolmitriptan Sumatriptan |
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What 2 agents SHOULD NOT be used within 24 hours of each other
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ergotamines and triampans unless caridac monitoring
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Tripans and what drugs increase the risk of Serotonin Syndrome (increase BP, HR, and body temp) what triptans in particular
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SSRI and LONG acting triptans
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When should MAO drug be D/C before use of triptans
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2 weeks
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75% of pts devleop cutaneous allodynia, which can be prevent if treated within
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30 minutes
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If wait to use triptan 1-2 after onset of migraine, triptans only do what
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reduce pain
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For 25% of pts does it matter when they take triptan (always work well)
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no
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How many times must you use a triptan do detmerine failure
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at least 3 HAs, and fail 2 or 3 then try a different triptan
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Does non-responders to one triptan correlate with non-reponse to ANOTHER
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NO----
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Isomethetene +dichlroaphenzone, and APAP is also what is dosing
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2 tablets at onset, then 1 every hour, max 5 in 12 hours or 8 per day
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Antimetics may also abort a migrane, if given IM or IV , what is 1st line in office visit
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Prochlorerpazines
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Lidocaines solution are also used for migraines, where are the administered
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issilater nostril
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What antiepticletic drug is used for moderate-severe migraines
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Depacon or IV valproatre
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Should natcrotics generally be avoided in mirgines
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YES
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What are the narcotics available
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Meperidien
Butophranol (NS) Butalbital |
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What is MOA of Ergot Derivates
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5HT1b/1d 1f and 5ht2 agoinsts,
alpha, beta and D2 |
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Should you be careful when pt last took tripan and decide when to give ergotamine b/c o fthe additive resposne, what do you monitor
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cardiac
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2 types of Ergot derivatives are Ergotamoine tartarte as a tabltes, dihydropergotamine as an injections--what has more effects on arteries and BP
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ergotamine
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What preganacy class are the ergot dervatices
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Class X
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